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Maxillofacial and Dental Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Exclude drug-induced dystonia to metoclopramide or phenothiazines on direct questioning, as this may mimic or even predispose to dislocation. Give benztropine (benzatropine) 1–2 mg i.v. followed by 2 mg orally once daily for up to 3 days if this is a dystonic reaction (see p. 276).
Cholinergic Antagonists
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Vishal S. Gulecha, Manoj S. Mahajan, Aman Upaganlawar, Abdulla Sherikar, Chandrashekhar Upasani
Parkinson’s disease (PD) characterized tremors and rigidity results from cholinergic overactivity in basal ganglia (Sharma and Sharma, 2017). The combination of antimuscarinic drugs with a dopaminergic drug is advantageous than using either drug alone. Most of the centrally acting antimuscarinics used in PD due to their ability to block muscarinic receptors in the striatum. These agents are used either alone in early stage or as an adjunct to levodopa in later stages of the disease. These drugs are also useful in relieving neuroleptic-induced extrapyramidal side effects. These drugs like benzhexol, procyclidine, benzatropine, and biperiden used in PD show adverse effects attributed to their anticholinergics effect that include dryness of mouth, blurred vision, confusion, reduced secretions, decreased motility as in urinary and gastric retention, hallucinations, and so on (Rang et al., 2003; Sharma and Sharma, 2017).
Drug therapy
Published in Jeremy Playfer, John Hindle, Andrew Lees, Parkinson's Disease in the Older Patient, 2018
It is a common misconception that these drugs are effective in preventing Parkinson’s signs and tardive dyskinesias in patients on neuroleptic drugs, whereas in fact they may worsen both of these conditions.44 Procyclidine and benzatropine, when given parenterally, have been shown to be effective as an emergency treatment for acute drug-induced dystonic reactions, and this is probably now their main indication for use.45
VMAT2 Inhibitors for the Treatment of Tardive Dyskinesia
Published in Issues in Mental Health Nursing, 2022
Barbara Warren, Dawn Vanderhoef, Jessica Johnson
Study designs were generally similar between the trials with the most noteworthy difference being the longer treatment period in the deutetrabenazine studies, which is presumably due to the 4- or 6-week titration period needed to achieve a therapeutic deutetrabenazine dose. In addition, there were some differences in the eligibility requirements. For example, the deutetrabenazine studies required patients to have an AIMS total score ≥6 at screening and baseline; in contrast, the AIMS total score was not an inclusion criterion for the valbenazine studies, although moderate or severe TD was required at screening per assessment of screening videos by external reviewers. In addition, the valbenazine studies allowed participants to continue stable doses of concomitant anticholinergics, while the deutetrabenazine studies excluded patients taking strong anticholinergics (e.g., benztropine). The primary efficacy endpoint in all the studies was change from baseline to Week 6 in the AIMS total score (sum of items 1–7), as assessed by two blinded central video raters who were movement disorder specialists. Additional efficacy assessments were similar across studies, but for the purposes of this review, we have focused on the clinician-rated global outcome measures: Clinical Global Impression of Change (CGIC) for AIM-TD and ARM-TD, and Clinical Global Impression of Change-Tardive Dyskinesia (CGI-TD) for KINECT 2 and KINECT 3. However, some long-term results for the Patient Global Impression of Change (PGIC) are also presented for context and to acknowledge the importance of patient-reported outcomes in clinical trials.
A Prospective Study of the Safety and Effectiveness of Droperidol in Children for Prehospital Acute Behavioral Disturbance
Published in Prehospital Emergency Care, 2019
Colin B. Page, Lachlan E. Parker, Stephen J. Rashford, Katherine Z. Isoardi, Geoffrey K. Isbister
There were 9 adverse events in 8 patients (8/102 [8%]; 95% CI: 3 to 13%). Five (5%) patients had hypotension (Table 2). Four were asymptomatic had systolic blood pressures BP >80 mmHg and resolved without intervention. The remaining patient had a systolic blood pressure of 75 mmHg in ED, was asymptomatic and responded to intravenous fluid. Two (2%) patients (age 7 and 12 years) had dystonic reactions (Table 2). In one patient this occurred in the ED approximately 2 hours after receiving droperidol. In the second patient, the dystonic reaction occurred post discharge approximately 4 hours after receiving droperidol. This patient was also on regular risperidone. Both patients responded to benztropine. One patient (15 year old female with alcohol intoxication) had a respiratory rate of 8 with oxygen saturations of 88% on room air, which resolved with the addition of oxygen.
Oculogyric Crisis with Downward Deviation – A Photo Essay
Published in Neuro-Ophthalmology, 2018
Hüseyin Nezih Özdemir, Neşe Çelebisoy
Treatment strategies are variable and depend on the aetilology of OGCs.1 In drug-induced OGCs, the first step of management should include removing or, if not possible, reducing the dose of the offending agent. 1 In acute cases, administration of anticholinergics, such as benztropine (e.g. 2-mg intravenous) and biperiden (e.g. 5-mg intramuscular) can be used.1 Oral administration of anticholinergics may be the most feasible approach for cases seen outside the emergency setting.1 In cases of persistent lack of response, oral treatment with benzodiazepines such as clonazepam (e.g. 0.5–4 mg) might provide symptom relief.1 However, it should be noted that treatment effects might be limited in tardive OGCs. 1 A few patients have been reported to exhibit drug-induced oculogyric crises that recurred spontaneously months to years after discontinuation of the offending dopamine receptor blocking agent. Episodes reoccurred spontaneously, but remained responsive to anticholinergics.6